Active NPI
Jordan Blaine Lundeen, DDS
- General Practice Dentistry
- Oklahoma City, OK
National Provider Identifier
1477498566
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8206
- Practice address
- 2828 NW 30TH St
Oklahoma City, OK 73112-7404 - Phone
- (405) 402-4680
- NPI assigned
- Apr 23, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8206 | OK | Primary |
Addresses
Primary practice location
2828 NW 30TH St
Oklahoma City, OK 73112-7404
Mailing address
3000 Drake Crest Dr
Edmond, OK 73034-0018
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8206 | OK | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1776902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1776902400000",
"number": "1477498566",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3000 DRAKE CREST DR",
"city": "EDMOND",
"state": "OK",
"postal_code": "730340018"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2828 NW 30TH ST",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731127404",
"telephone_number": "405-402-4680"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUNDEEN",
"first_name": "JORDAN",
"middle_name": "BLAINE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-04-23",
"last_updated": "2026-04-23",
"certification_date": "2026-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OK",
"license": "8206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.